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Independents' Day

Hospital trusts start drive to set up GP practices

Exclusive Management consultants have held seminars with several hospital trusts about setting up new GP practices as outlined in NHS England’s five-year plan, and have told Pulse they have seen a ‘huge appetite’ for the move.

PwC have been holding the seminars following NHS England’s Five Year Forward View, which outlined new ‘primary and acute care services’ (PACS) that would allow hospital trusts to use their surpluses to set up GP practices with their own registered list for the first time.

NHS England said the move would better integrate care, but GP leaders have warned a landgrab by hospital trusts would hold risks for GPs as it would allow trusts to ‘take over the world’.

Pulse has learned that PwC has observed an ‘extraordinary level of interest’ among trusts in setting up GP practices, as they could benefit from it financially and prevent the current drain of funds due to early discharge and community care schemes.

NHS England’s five-year view – which has since received Government backing via a £200m ‘transformation fund’ to begin the work in 2015 – puts forward two competing models of primary care, with GP practices setting up multiple community providers (MCPs) that would integrate more closely with secondary care, mental health services and community services – and hospitals setting up GP providers under PACS.

NHS England said PACS would only be allowed in areas where general practice is ‘under strain’, but could eventually become the equivalent of the ‘accountable care organisations’ in the US, which have responsibility for all patient care under a capitated budget.

Dr Tim Wilson, a partner in the PwC health sector team, told Pulse that trusts were seeing the financial opportunities in taking on GP practice lists: ‘For many hospitals looking down the barrels of a deficit, this gives them an option to do some good work and benefit from it financially.’

Dr Wilson said that PwC had begun holding meetings for potential providers of both models, saying that NHS England’s plans had ‘tapped into the zeitgeist of the NHS’.

He said: ‘PwC has held meetings for organisations interested in the PACS and MCP models of care… Holding these meetings was a natural next step for organisations interested in providing better outcomes for patients in a more sustainable fashion, to help them work out what it is they need to do next. This is not going to be easy, and there is a lot for them to think through, not least of all, which model (PACS or MCP) their system should be exploring.

‘There is an extraordinary level of interest amongst providers and commissioners in these new models. I think the Five Year Forward View has tapped into the zeitgeist of the NHS, and indeed social care. I think when these models were promoted people were saying “yes, that is exactly it, what we have been wanting for the last few years”. There is a huge appetite from trusts, GPs, social workers, community providers and commissioners.’

Recalling a conversation with a trust chief executive client, Dr Wilson said: ‘He has a vertically integrated organisation in that he has a hospital integrated with community services, and he said “the problem I’ve got is that we’re getting better and better at looking after older people, I’ve got a team going round A&E, they spot the older people and they stop them going into hospital, they go in and are able to get them out early, but every time I do that I lose money”. He wants to be a PACS for the money to work more to be able to do more preventative work.’

Dr Wilson said he thought these new models would be going live within two or three years. He said: ‘It is likely to be a couple of years before these organisations are actually in existence from an actual formal point of view, they are two or maybe three years out. However, we envisage that there will be quite a lot of improvement in care delivery along this route, I think patients will actually start to experience improvement within six months.’

But NHS Alliance chair Dr Michael Dixon said there were dangers connected to the PACS model. He said; ‘There’s a real danger that the outcome of a hospital-dominated, secondary-care dominated model is that general practice become largely salaried, with GPs losing their status as independent contractors.

‘With very large hospital trusts, there’s a danger that GPs would become the front-line drones, rather than being at the centre of the system.

‘My fear is that some hospitals will see this as an opportunity to take over the world. There would be good reasons for hospitals to take on general practice: they could make sure that local practices only referred to that hospital, and they could also bump up their income. The danger is that this will create further flow of money into secondary care away from primary care.’

The news comes as former RCGP chair Professor Clare Gerada, who is now an NHS England (London) adviser, has predicted that there will be no more GP partnerships in London within a decade.

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Readers' comments (29)

  • yet again, not really talking to the current contractors- us.
    Will the hospital buy our buildings?
    Just in our small town thats going to cost a few million.

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  • 'benefit from it financially'

    Good luck with that one.

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  • noise and gibberish. the sort of funding required to try this experiment is significant and would need funding diverted from elsewhere.

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  • "Anonymous | GP Partner | 16 December 2014 10:32am
    yet again, not really talking to the current contractors- us.
    Will the hospital buy our buildings?
    Just in our small town thats going to cost a few million."

    They don't need to. Put up a couple more portakbins in the hospital grounds and they are off and running, taking patients away from you and financially destabilising general practice. The hospitals (and politicians) don't realise how much more goes on in general practice than just seeing the GP or nurse, they have no idea about the vast back-office load of patient queries, repeat prescribing, insurance medicals, blue badge forms etc etc etc but by the time the backlog of problems they create really becomes a big problem they will have destroyed much of the GP competition. Which is what the politicians want.

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  • Harry Longman

    I'm all for experimenting, but do the hospitals realise that over 95% of patients presenting to GPs are dealt with there in primary care? The crossover is, to some, surprisingly small. And A&E demand, less than 1/10th of GP. Intuitively this looks odd.

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  • perverse... hospitals are famous for inefficiency and layers of bureaucracy. The opposite of primary care.

    Completely different worlds. We have seen hospitals fail when they have taken over neighbouring trusts, because they can't deal with different issues. This has the potential to cause havoc.

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  • Would the final destruction of general practice require legislation?
    And do hospitals - or Simon Stevens - or PwC - have any concept of the breadth and variety of structured care services general practice is expected to deliver?
    What about medical records - and record systems - and locating practices close to the populations they theoretically serve?

    And the idea that a provider (hospital) can take over the commissioners (assuming that the commissioning function is supposed to remain with CCGs composed of GP practice members) sounds like a case for the competition regulators....

    Don't suppose any of this will stop Simon Stevens and NHS England from going ahead with the conversion of the NHS to a US model

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  • Do they understand the concept of conflict of interest?

    Hospital run GP refers patients. Hospital sees the patient and charges CCG as per agreed tariff. Increase in the number of referrals and hospital trusts get richer whilst CCG plummets further into debt.

    Just one example of COI. There are many more

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  • Glad I'm working my notice as a GP partner.

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  • PwC is probably being paid quite well to work on plans which are unrealistic. I am sure they have brilliant brains concocting PACS and maybe more wax becuase NHS is a golden goose.
    Are the hospital Consultants going to see patients in these GP Clinics, that is the question. The exodus needs to be stemmed first because it's the horse and not the cart that leads. Without GPs on board, you will just have another failed experiment.

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